Development of a Brief Mindfulness-Informed Cognitive–Behavioural Therapy Intervention to Pair With Pharmacist-Led Benzodiazepine Tapering for Older Adults: The CSTARS Intervention

Abstract

Benzodiazepines are potentially inappropriate medications for older adults, and deprescribing interventions are needed. We describe the development of a psychologist-led, mindfulness-informed cognitive–behavioural therapy (CBT) intervention to pair with pharmacist-led tapering to support benzodiazepine deprescribing in older adults. Based on previous research, we first developed an intervention conceptual model. The aim of this study was to (1) gather stakeholder feedback on previous experiences with benzodiazepine tapering and on our intervention model and proposed intervention, and (2) integrate this qualitative feedback to develop an intervention manual. We conducted (a) semistructured individual interviews with older adults (N = 8) who previously attempted to taper their benzodiazepines, and (b) a focus group with members (N = 5) from a national deprescribing patient stakeholder group. Overlapping themes emerged, including support for the mindfulness-informed CBT intervention, the importance of control over taper pace, the need for a goal- and skills-oriented intervention, the importance of normalizing side effects of the taper and building confidence to manage side effects and the utility of fostering acceptance during the taper. These findings informed the development of a final intervention manual, named Confidence-Building Strategies for Reducing Sedative Medications (CSTARS), to be tested in a single-arm pilot feasibility trial.